[Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years' experience)]. / I tumori tubulo-villosi del retto. Risultati delle exeresi chirurgiche in funzione dell'istotipo. Esperienza di 30 anni.

Adenomas of the rectum are frequently found during endoscopic examination. We report on our 30 years of experience with the treatment of tubulo-villous adenomas based on histotype. Between 1971 and 2001, 104 villous tumours of the rectum were treated surgically. The patients' average age was 65 years. These were sessile tumours in 69% of cases, pedunculated in 17.5% and flowing tumours in 13.5%. The mean tumour size was 3 cm. They were associated with colon cancer in 15% of cases and with polyadenoma in 10%. They were located in the rectum within 0 to 6 cm of the anal margin in half the cases. These tumours were treated by local excision in 74 cases and by wide excision in 30 cases. The malignant potential of the tumours was 30%, including 10% invasive malignancy. There were no surgical fatalities, but a 6% medical fatality rate was registered. There was a 20% complication rate related to the surgical technique. Twenty patients were lost to follow-up. Out of 84 villous tumours, monitored over a mean survival period of 6.5 years, there were 24 recurrences: 18 underwent endoscopic excision and in 6 cases a wide resection. The various tumour resection techniques and the operative indications of variable difficulty are presented. It would seem, at present, that total resection of the rectum with a colo-anal anastomosis is the best treatment for large flowing villous tumours occupying almost the entire rectum. Thorough preoperative examination and the mastering of various surgical procedures should allow the most suitable choice of treatment for each individual case.

[Voluntary or accidental ingestion of foreign bodies: clinical considerations in 142 cases]. / L'ingestione volontaria o accidentale di corpi estranei: considerazioni cliniche su 142 casi.

The authors report on a series of 142 patients who had swallowed foreign bodies over the period 1981-1999. After outlining the various ways in which the foreign bodies were swallowed and the fact that they were eliminated spontaneously by natural routes in 80-90% of cases, the authors deal at some length with the serious complications that occurred in some of these cases, which, as a result of their characteristics and mode of ingestion, may require emergency surgery for their resolution. In particular, the authors describe 6 cases of foreign bodies that were urgently removed by endoscopy and also describe 3 cases in detail (1 perforation and 2 bowel obstructions) in which a laparotomy was required not only to correct the complication but also to definitively clarify the diagnosis.